Provider First Line Business Practice Location Address:
6725 MESA RIDGE RD
Provider Second Line Business Practice Location Address:
SUITE 224
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92121-2923
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-224-1866
Provider Business Practice Location Address Fax Number:
858-224-1867
Provider Enumeration Date:
06/26/2006